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Marie Somogyi, Sarah Hale, David K Yoo, Yasmin Shayesteh; Final Diagnosis in Headache Patients Following Temporal Artery Biopsy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5557.
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Giant cell arteritis (GCA) is a diagnosis made based on a combination of signs, symptoms and laboratory evidence (1). Temporal artery biopsy is the gold standard for the diagnosis of GCA and a referral for biopsy is commonly encountered entity in oculoplastic surgery practice (2). Our review investigates the final diagnosis and clinical course of headache patients undergoing temporal artery biopsy with the suspicion of giant cell arteritis (GCA). To our knowledge, this series of 143 patients is the largest study to date evaluating the final diagnosis in temporal artery biopsy patients from a single institution.
Retrospective chart review of 143 patients who underwent a temporal artery biopsy from January 2006 to April 2014 by vascular surgery, plastic surgery and oculoplastic surgery at our institution.
Of 143 patients, 15 had positive biopsies (10.5%) and 128 had negative biopsies. Among the patients with negative biopsies, 41 patients (28.7%) ultimately were given the diagnosis of a benign headache. Biopsy-negative GCA was diagnosed when the American College of Rheumatology classification (7) criteria were met, symptoms improved within 3 days of corticosteroid therapy and no other diagnosis relevant to the patient’s presenting symptoms was diagnosed. 30 patients (20.9%) were ultimately diagnosed with biopsy-negative GCA. Of the remaining negative biopsies, 7 (4.9%) were found to have non-arteritic anterior ischemic optic neuropathy, 3 (2.1%) had isolated polymyalgia rheumatic, 3 (2.1%) with systemic vasculitis, 3 (2.1%) with acute angle closure, 3 (2.1%) with hypertensive urgency, 2 (1.4%) with posterior ischemic optic neuropathy, and 2 (1.4%) with granulomatosis with polyangiitis.
Even though only 15 patients (10.5%) had positive temporal artery biopsies, a total of 45 patients (31.5%) were ultimately treated for giant cell arteritis. Although the majority of patients (41 patients or 28.7%) undergoing temporal artery biopsy were diagnosed with benign headache, it is important to consider other vision and life threatening entities when presented with a patient with suspected GCA.
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